Things to Know from the CMO

The evaluation of effectiveness regarding Emergency Medical Services and our impact on the public health often focus on the distinctly clinical: Was the resuscitation of a patient with a shockable rhythm successful? Did we provide aspirin and navigate the patient with ST Segment Myocardial Infarction to the cardiac cath lab promptly? Can we identify patients with large vessel occlusion stroke and route those individuals for thrombectomy? Indeed, these and similar issues are critically important and worthy of our attention.

Equally worth of our attention, however, are the legislative and policy initiatives that also have tremendous impact on the ability of EMS to impact the public health. The initiatives worthy of our efforts are not Democrat vs. Republican, urban vs. rural, North vs. South – rather, these are issues that require all of our support to assure they are heard and understood by our elected officials. It is not that our cause is not just or our motives are not pure but rather that in the overall scheme of things our issues often become lost in the daily clamor that is characteristic of our political process. Two examples will illustrate the point.

First, several years ago, the Drug Enforcement Administration (DEA) undertook a very laudable policy initiative, namely to assure that everyone who interacted with controlled substances was doing so in a manner consistent with the Controlled Substances Act (CSA). The emerging opioid crisis required an “all hands on deck” approach and cleaning up the administrative components of the CSA made perfect sense. During presentations from DEA officials at both the American College of Emergency Physicians (ACEP) and the National Association of EMS Physicians (NAEMSP) conferences, it became very clear that there was going to be an unintended consequence of this policy initiative: EMS would lose the ability to administer any controlled substance via standing order or protocol! It was also unclear exactly how an EMS agency could properly store and secure controlled substances, even if the issue with protocols could be addressed. Leadership from multiple EMS organizations began conversations with DEA leadership, only to learn that their administrative options were extraordinarily limited by the language of the CSA. To solve this problem, we needed to change the federal law. There was essentially no opposition to the Protecting Patient Access to Emergency Medications Act, the law that would allow for continued, appropriate use of controlled substances by EMS. Despite the lack of opposition, it took over 3 years and passage in the US House in two different congressional sessions before the Senate passed the bill and President Trump signed it.

Now, recurring drug shortages have again become a critical issue. EMS agencies across the United States are finding themselves with incredibly low supplies of basic medications such as IV fluids, anti-emetics, pain control, and medications required for emergent airway management. Just as with the issue regarding controlled substances, there are few (if any) lawmakers who are in support of these continued critical shortages; the urgent need is for EMS to elevate this issue above all of the other more contentious issues so that we can assure continuing availability of life saving and life sustaining medications.

All EMS providers should consider interaction with our legislative leaders with a sense of urgency; obviously, response to the patient with witnessed sudden cardiac arrest will always take a great urgency, but in order to have the tools we need to respond in the future, we need to take legislative action now.